Determinants of gastric cancer screening attendance in Southeastern China: a cross-sectional study

OBJECTIVES: This study aimed to identify the determinants of gastric cancer screening attendance among individuals aged 40 years in a region with high gastric cancer in China.

DESIGN: An anonymous, cross-sectional survey was conducted between October 2021 and March 2022.

SETTING: A self-administered online survey was conducted in Fujian Province in Southeastern China.

PARTICIPANTS: People aged 40 years living in five selected cities in Fujian Province with no history of cancer.

MAIN OUTCOME MEASURES: Gastric cancer screening attendance was measured with the question 'Have you ever been screened for gastric cancer in the past'.

RESULTS: In total, 2547 complete responses were obtained. The mean age of respondents was 47.72±7.20 years, and 59.8% were men. A total of 42.6% of participants reported that they had undergone gastric cancer screening. The result of multivariable logistic regression analysis showed that participants with a first-degree relative affected with gastric cancer (OR=2.02, 95% CI: 1.58 to 2.59) and high perceived susceptibility of gastric cancer (OR=2.03, 95% CI: 1.58 to 2.59) were the strongest facilitators for screening attendance. Other factors positively associated with screening attendance were age 51-60 years (OR=1.69, 95% CI: 1.31 to 2.18), living in urban regions (OR=1.27, 95% CI: 1.05 to 1.55), friends/neighbours/colleagues with gastric cancer (OR=1.30, 95% CI: 1.07 to 1.58), history of chronic gastric disease (OR=1.90, 95% CI: 1.57 to 2.30), perceived high cost (OR=1.28, 95% CI: 1.01 to 1.61) and physician recommendation (OR=1.71, 95% CI: 1.36 to 2.16). On the other hand, factors negatively associated with screening attendance included perceived barriers, namely screening is only necessary when symptoms present (OR=0.71, 95% CI: 0.58 to 0.87) and perceived appointment for gastroscopy screening is difficult and time-consuming (OR=0.75, 95% CI: 0.60 to 0.94). No significant association was found between knowledge level and participation in screening.

CONCLUSION: This study highlights important individual-level factors and barriers to gastric cancer screening. Strategies targeting under-screened populations and eliminating patient-perceived barriers to gastric cancer screening are essential.